Fibrocystic Breasts

The term fibrocystic breasts, also called fibrocystic mastopathy or mastopathia fibrosa cystica, describes a change in the connective tissue of the breasts.

Two types of changes are typical:

• fibrosis – a proliferation of connective tissue
• cysts – small, liquid-filled cavities in the tissue.

The breasts can feel knotty, hardened, or even be painful. Discharge from the nipples can also occur. The symptoms often change during the menstrual cycle.

Fibrocystic mastopathy is not a cancer. It is the most common benign tissue change experienced in the breasts and affects about every second woman. Premenopausal women between the ages of 30 and 50 years are often affected. Fibrocystic mastopathy is a collective term with numerous subtypes of the condition, some of which have very different characteristics.

The changes in tissue can make breast cancer screening more difficult and should always be clarified in order to rule out serious diseases. Individual subtypes can increase the risk of breast cancer. In most cases, however, no treatment is required. 1, 2, 3, 4

If you think that you might have fibrocystic breasts, you can try using the Ada app to find out more about your symptoms.

Fibrocystic changes in the breast occur in women of childbearing age and usually subside with the onset of menopause. The tissue changes depend on the menstrual cycle. Pregnancy and lactation also have an effect on these tissue changes. Although the exact mechanisms have not yet been clarified, it is assumed that the changes are a reaction to the fluctuations of the hormones estrogen and progesterone in the body. High oestrogen levels and low progesterone concentrations seem to increase the likelihood of the development of fibrocystic breasts. 3, 4, 5, 6, 7

Factors that increase the risk are: 3, 6, 7

• Women of childbearing age
• Women who have not yet had a child
• late onset of menopause
• being overweight
• higher age at birth of first child
• Hormone replacement therapy with estrogen

Factors that reduce the risk are: 3, 6, 7

• Women who have given birth to several children
• Treatment with tamoxifen (a drug from breast cancer treatment)

The symptoms in women with fibrocystic breasts can vary from woman to woman. Since the term also encompasses a number of different subtypes as a collective term, the possible complaints also vary depending on the subtype present.

The symptoms are often most severe a few days before the onset of menstruation and decrease shortly after the onset of menstrual bleeding. In addition, the symptoms are often symmetrical and occur in both breasts. However, some women who are diagnosed with fibrocystic mastopathy have not noticed any symptoms beforehand. 3, 4, 8

Possible symptoms are: 3, 4, 8

Pain in the breasts

• can be dependent on the course of the menstrual cycle
• are often persistent and dull
• are sometimes also perceived as throbbing or burning
• mostly diffuse in both breasts, partly also with pain peaks at separate locations

Pressure painfulness during palpation (Nodes in the breasts)

• mostly symmetrical in both breasts
• often in numerous locations

discharge from the nipples

• can be grayish, greenish, dark, or milky
• in rare cases also bloody/watery and with a high quantity
• can occur on one or both sides

Change in breast size local hardening which is palpable

If you think that you might have fibrocystic breasts, you can try using the Ada app to find out more about your symptoms.

Often lumps in the breast are noticed by the affected women themselves or are noticed during a routine examination. However, there are a number of different possible causes for this, which require further evaluation.

A gynaecologist will first ask about the symptoms, their course and the medical history in a so-called anamnesis. The doctor will then perform a thorough physical examination focussing on the inspection and palpation of the breast. This can confirm the suspicion of a tissue change and further examinations can be requested in order to arrive at the correct diagnosis. 2, 3, 4, 9

The following diagnostic methods can be used: 3

• Ultrasound of the breast
• Mammography
• Biopsy

Ultrasound and mammography examinations are usually performed on all affected women who: 3

• Have a known, persistent lump in their breast
• Show a lump in their breast during a physical examination
• Suspicious discharge from one or both nipples

A biopsy is only necessary if the other two examination procedures confirm the suspicion of a change in the breast tissue.

1) Ultrasound of the breast:

Ultrasound is a procedure in which the reflection of sound waves is used to show differences in density of the tissue. The procedure is easy to use and has no negative side effects.A doctor can use it to obtain images of the inner breast tissue. In particular cysts, small, liquid-filled cavities, can be identified and examined well in this way. 1, 3

There are different types of cysts, which have to be evaluated differently: 1, 3

Simple cyst:

• This type of cyst appears on the ultrasound image as a small cavity that is filled exclusively with fluid and can be clearly defined
• Simple cysts are completely harmless and are not pathological
• If the cyst causes pain, the inner fluid of the cyst can be punctured under ultrasound control

Complicated or complex cysts:

• In addition to liquid components, solid components can also be found here
• These types of cysts require further evaluation in order to rule out malignancy

Good to know: Depending on the menstrual cycle, cysts can increase and decrease in size and thus trigger tension pains. The pain typically occurs in the days before menstruation and subsides quickly after the onset of menstruation.

2) Mammography:

Mammography is an X-ray of the breasts. This allows the doctor to check for any abnormal cell growth and structural changes within the the breast tissue. In women with fibrocystic mastopathy, the images usually show circumscribed areas with increased density. However, in order to distinguish a harmless finding from a malignancy, a biopsy following mammography will be necessary. 3

Good to know: The diagnostic value of a mammography can be limited, especially for women under 40 years of age, as the breast tissue in this age group is even denser than in older women. This can make it more difficult to find pathological densifications. 8

3) Biopsy:

A biopsy is a procedure in which a tissue sample or liquid is obtained using a needle. The cells from the tissue sample are then examined under a microscope and examined for possible degenerations. This way, an exact diagnosis can be made. 3, 10, 11

There are different types of biopsies that are used depending on the nature and localization of the tissue in question. The procedures are performed under local anesthesia, thus avoiding pain.

Good to know: About 80 percent of women who undergo a breast biopsy do not have breast cancer. 10

Most women affected by fibrocystic mastopathy do not require specific treatment. However, if symptoms are found to be restrictive, the symptoms can be specifically treated and thus alleviated. 3

The following can help with pain in the breasts: 1, 2, 3, 4, 9

Wearing a supporting bra

• This can reduce the feeling of tension

Taking over-the-counter painkillers

• Should only be taken temporarily and in consultation with a doctor or pharmacist

Warm compresses

• can be tried out individually

If the woman is under hormone replacement therapy, a modification of this may be considered

• Should only be carried out in consultation with the treating physician

Diet changes

• Little scientific evidence
• Can be tried out individually
• Reduction of the intake of caffeinated beverages
• Reduction of food with high salt content
• Fibre-rich, low-fat diet

Hormone therapy

• Severe pain lasting at least 6 months
• In consultation with the attending physician
• Due to possible side effects usually only used in intervals

Puncturing of simple cysts that cause symptoms

• With a biopsy needle under ultrasound control
• Can be repeated if necessary
• If simple cysts don’t cause any complaints, however, there is no need for any measures

If there is discharge from the nipples: 3

• If the discharge has been evaluated by a doctor and classified as harmless, it is sufficient to observe the discharge from there on
• Use bra inserts
• Changes in outflow, especially bloody or extensive outflow, should be re-examined by a physician

If you think that you might have fibrocystic breasts, you can try using the Ada app to find out more about your symptoms.

There are currently no scientifically proven measures to prevent fibrocystic mastopathy. Some women describe an improvement in symptoms after reducing caffeine-containing drinks and salty foods. 3

Breast pain caused by fibrocystic mastopathy usually persists chronically for years and occurs in episodes. Two thirds of all affected women require hormone treatment at times to effectively alleviate the symptoms.With the onset of menopause, the pain usually disappears by itself. 2, 3, 4

Whether there is an increased risk of cancer depends on the subtype of fibrocystic mastopathy. This can be analyzed by retrieving a tissue sample. If there is an increased risk of malignancy, the doctor can then initiate the appropriate treatment steps. 4

Development of breast cancer:

About 4% of all women affected by fibrocystic mastopathy are at increased risk of developing breast cancer. This depends on the subtype of fibrocystic mastopathy and can be clarified with a tissue sample. 3

If you think that you might have fibrocystic breasts, you can try using the Ada app to find out more about your symptoms.